029 - CERAB: a New Frontier for Extensive Aortoiliac Occlusive Disease
Rakesh Ahuja, MD – Attending Physician, Interventional Radiology, University of Texas at Houston; Kumar Madassery, MD – Attending Physician, Interventional Radiology, Rush University
Purpose: To delineate the feasibility and safety of the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) technique for the treatment of extensive aortoiliac occlusive disease (AIOD) via review of current literature.
Material and Methods: A literature search was performed using multiple databases (MEDLINE, Cochrane Library, EMBASE) where three recent studies with CERAB were found. Pooled meta-analysis was gathered for number of patients treated, patient Trans-Atlantic Inner-Society Consensus (TASC-II) lesion type, 30-day morbidity and mortality, and 3-year patency rates.
Results: 247 patients were analyzed across three studies. Lesions included TASC-II D (n=216, 87.4%), TASC-II C (n=17, 6.9%), and TASC-II B (n=14, 5.7%). Technical success was 96.4% (n=238). Technical failures in 8 patients (3.2%) were due to failure of lesion recanalization, while the lesion could not be passed in 1 (.4%) case. Procedural complications included dissection (n=12), vessel thrombosis (n=4), rupture/bleeding (n=4), stent dislocation (n=3), and stent deformation (n=1). Post procedural (30-day) morbidity and mortality was 10% (1-26%) and 0%, respectively (pooled weighted proportion, 95% CI). Major postprocedural complications included thrombosis (n=4), pneumonia (n=3), kidney failure (n=2), stent dislocation (n=1), and multiple organ dysfunction (n=1). Minor postprocedural complications included access site hematoma (n=31), pseudoaneurysm (n=5), fever of unknown cause (n=4), rebleeding (n=3), and atrial fibrillation (n=2). Patency rates were available to three years (pooled weighted proportion, 95% CI). Primary patency was 88% (83-92%) at one year and 82% (75-85%) at three years. Secondary patency was 97% (94-99%) at one year and 97% (92-99%) at three years.
Conclusions: This meta-analysis examines recent studies of the CERAB technique for treatment of extensive aortoiliac occlusive disease. This technique is safe with a high technical success rate. CERAB is especially useful for TASC-II D lesions but can also be used to treat TASC-II C and TASC-B lesions in some cases and may offer an alternative to conventional stent grafting and bypass surgery. Primary and secondary patency rates were favorable at one and three years; further experience is needed to determine longer-term outcomes. CERAB was associated with no 30-day mortality but is not without management challenges of intra and periprocedural complications.